Gambaran Klinis dan Tata Kelola Batu Saluran Kemih pada Bayi dan Anak-anak

Abstract

Abstrak

Prevalensi batu saluran kemih pada anak saat ini berkisar 2-3%, sedangkan tingkat rekurensinya dapat mencapai 6,5-54%. Penyebabnya sebagian besar faktor metabolik. Penyebab lain berupa kelainan anatomis dan infeksi saluran kemih. Jenis batu paling sering berupa  batu kalsium oksalat (40-60%), dan paling jarang berupa batu urat (2-10%). Lokasi batu sebagian besar di ginjal pada anak berusia 0-5 tahun (68%). Sedangkan batu pada uretra lebih sering ditemukan pada kelompok anak berusia 6-10 tahun (64%), dan berusia 11-18 tahun (82%).

Keluhan yang dirasakan dapat berupa nyeri perut yang tidak khas, mudah menangis, muntah, sulit mengeluarkan urine, tidak nafsu makan dan sering memegang alat kelaminnya tanpa sebab yang jelas. Namun sebagian anak ada yang tidak mengeluhkan gejala sama sekali. Selain anamnesis yang teliti, diperlukan pemeriksaan radiologis seperti USG (utama), Foto Polos Abdomen atau Spiral CT Scan (dilakukan sesuai indikasi) untuk mencari kelainan anatomis dan mengetahui lokasi batu. Pemeriksaan urinanalisa yang diperlukan antara lain derajat keasaman (pH) urine, dan pemeriksaan urine 24 jam untuk mengetahui kandungan kristal (seperti kalsium, oksalat, sitrat, asam urat, magnesium, fostat, sistin dan kreatinin) pada urine. Pemeriksaan serum (darah), sebaiknya diperiksa kadar Ca, PO4, Na, K, HCO3, asam urat, Mg, Kreatinin serum, serta kadar alkalin fosfatase. Jika batu keluar secara spontan, pemeriksaan analisa batu sangat berguna untuk penegakan diagnosis, penentuan jenis batu dan mencegah terjadinya batu saluran kemih berulang.

Penanganan batu saluran kemih pada anak dapat berupa pemberian analgetik, peningkatan intake cairan untuk meningkatkan volume urine, dan tindakan operatif seperti pembedahan terbuka (open stone surgery), ureteroskopi, Extracorporeal shock wave lithotripsy (ESWL), hingga Percutaneous nephrolithotomy (PCNL).

 

Kata kunci: Batu saluran kemih, anak, keluhan, pemeriksaan

 

 

Abstract

The prevalence of urinary tract stones in children is now about 2 to 3%, while the recurrence rate can reach 6.5 to 54%. The largest cause being metabolic factors. Other causes are anatomic abnormalities and urinary tract infections. These types of stones are most often in the form of calcium oxalate stones (40-60%), while the least common form is urate stones (2-10%). The location is most often in the kidneys in children aged 0-5 years (68%). Whereas stones in the urethra are more often found in the group of children aged 6-10 years (64%) and aged 11-18 years (82%).

While complaints of abdominal pain are not typical, patients often suffer from: crying easily, vomiting, difficulty passing urine, loss of appetite, and often touch their genitals for no apparent reason. However, some children do not complain of any symptoms at all. In addition to a careful history, radiological examinations are required, including ultrasounds (foremost), Plain Abdominal x-ray or Spiral CT Scans (performed as indicated) to search for anatomical abnormalities and to know the location of the stone. Urinanalysis examinations are required, among other analyses, to measure the degree of acidity (pH) of urine and a 24-hour urine test to determine the content of crystals (such as calcium, oxalate, citrate, uric acid, magnesium, phosphate, cystine and creatinine) in the urine. Examination of serum (blood) should be conducted as well as examination of levels of: Ca, PO4, Na, K, HCO3, gout, Mg, serum creatinine, and alkaline phosphatase levels. If the stones come out spontaneously, stone analysis is very useful for diagnosis as well as determining of the type of stone in order to prevent recurrent urinary tract stones.

Handling of urinary tract stones in children can be pain relief, increase fluid intake to increase urine volume and take operative measures, such as open surgery (open stone surgery), ureteroscopy, extracorporeal shock wave lithotripsy (ESWL), or Percutaneous nephrolithotomy (PCNL).

 

Key words: Urinary tract stone, children, complaint, examination